- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $917.96 / $917.96 / $917.96
| Facility | | $917.96 | $917.96 | $917.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,300.85 / $9,560.76 / $20,256.65
| Facility | | $4,300.85 | $9,560.76 | $20,256.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,028.17 / $2,876.20 / $6,919.09
| Facility | | $2,028.17 | $2,876.20 | $6,919.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,648.76 / $2,629.54 / $5,448.10
| Facility | | $1,648.76 | $2,629.54 | $5,448.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,311.85 / $1,878.46 / $12,367.00
| Facility | | $1,311.85 | $1,878.46 | $12,367.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,577.00 / $10,743.00 / $12,774.00
| Facility | | $5,577.00 | $10,743.00 | $12,774.00 |